Patterns and predictors of 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys: treatment in the context of perceived need

Dan J Stein¹, Daniel V Vigo^{2

3}, Meredith G Harris^{4

5}, Alan E Kazdin⁶, Maria Carmen Viana⁷, Irving Hwang⁸, Timothy L Kessler⁹, Sophie M Manoukian⁸, Nancy A Sampson⁸, Jordi Alonso^{10

11

12}, Laura Helena Andrade¹³, Corina Benjet¹⁴, Ronny Bruffaerts¹⁵, Brendan Bunting¹⁶, Graça Cardoso¹⁷, Stephanie Chardoul¹⁸, Giovanni de Girolamo¹⁹, Peter de Jonge²⁰, Oye Gureje²¹, Josep Maria Haro^{11

22

23}, Elie G Karam^{24

25

26}, Viviane Kovess-Masfety²⁷, Jacek Moskalewicz²⁸, Fernando Navarro-Mateu^{11

29

30}, Daisuke Nishi³¹, José Posada-Villa³², Kate Scott³³, Juan Carlos Stagnaro³⁴, Cristian Vladescu^{35

36}, Jacek Wciórka²⁸, Zahari Zarkov³⁷, Ronald C Kessler³⁸; WHO World Mental Health Survey collaborators

Collaborators, Affiliations

Collaborators

Affiliations

¹ Department of Psychiatry & Mental Health and South African Medical Council Research Unit On Risk and Resilience in Mental Disorders, University of Cape Town, Rondebosch, Cape Town, 7925, ZA, South Africa.
² Department of Psychiatry, University of British Columbia, UBC Hospital-Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada.
³ Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
⁴ School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD, 4108, Australia.
⁵ Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
⁶ Department of Psychology, Yale University, 2 Hillhouse Avenue, 208205, New Haven, CT, 06520, USA.
⁷ Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Rua Dr. Euríco de Águiar, 888/705, Vitoria, Espirito Santo-ES, 2905-600, Brazil.
⁸ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
⁹ The Watson Institute for International and Public Affairs, Brown University, Providence, RI, United States.
¹⁰ IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, 08003, Barcelona, Spain.
¹¹ CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
¹² Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain.
¹³ University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica-LIM 23, Rua dr. Ovidio Pires de Campos, 785, São Paulo, CEP, 05403-010, Brazil.
¹⁴ National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, Col San Lorenzo Huipulco, CDMX 14370, Mexico City, Mexico.
¹⁵ Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, UZ Herestraat 49, Box 7003, 3000, Louvain, Belgium.
¹⁶ School of Psychology, Ulster University, Coleraine Campus, Coleraine, BT52 1SA, UK.
¹⁷ Lisbon Institute for Global Mental Health, Comprehensive Health Research Centre Nova University of Lisbon, Rua do Instituto Bacteriológico, 5, 1150-190, Lisbon, Portugal.
¹⁸ Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA.
¹⁹ IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy.
²⁰ Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
²¹ Department of Psychiatry, University of Ibadan, University College Hospital, PMB 5116, Ibadan, Nigeria.
²² Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
²³ Departament de Medicine, Universitat de Barcelona, Barcelona, Spain.
²⁴ Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon.
²⁵ Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Ashrafieh, Beirut, 166378, Lebanon.
²⁶ Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon.
²⁷ Institut de Psychologie, UR 4057, Université Paris Cité, 71 Avenue Édouard Vaillant, 92100, Boulogne Billancourt, Paris, France.
²⁸ Department of Psychiatry, Institute of Psychiatry and Neurology, Jana III Sobieskiego 9, 02-957, Warsaw, Poland.
²⁹ Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/Lorca, nº 58. -El Palmar, 30120, Murcia, Spain.
³⁰ Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, 30120, El Palmar, Murcia, Spain.
³¹ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
³² Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Calle 28 # 5B 02, 11001000, Bogotá, Colombia.
³³ Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
³⁴ Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Ciudad Autónoma de Buenos Aires, Argentina.
³⁵ National Institute for Health Services Management, Strada Vaselor 31, 030167, Bucharest, Romania.
³⁶ University Titu Maiorescu, Calea Văcărești 187, Bucharest, Romania.
³⁷ Department of Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd., Sofia, 1431, Bulgaria.
³⁸ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA. kessler@hcp.med.harvard.edu.

PMID: 40082956
PMCID: PMC11907907
DOI: 10.1186/s13033-025-00661-1

Patterns and predictors of 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys: treatment in the context of perceived need

Dan J Stein et al. Int J Ment Health Syst. 2025.

. 2025 Mar 14;19(1):10.

doi: 10.1186/s13033-025-00661-1.

Authors

Collaborators

Affiliations

¹ Department of Psychiatry & Mental Health and South African Medical Council Research Unit On Risk and Resilience in Mental Disorders, University of Cape Town, Rondebosch, Cape Town, 7925, ZA, South Africa.
² Department of Psychiatry, University of British Columbia, UBC Hospital-Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada.
³ Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
⁴ School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD, 4108, Australia.
⁵ Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
⁶ Department of Psychology, Yale University, 2 Hillhouse Avenue, 208205, New Haven, CT, 06520, USA.
⁷ Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Rua Dr. Euríco de Águiar, 888/705, Vitoria, Espirito Santo-ES, 2905-600, Brazil.
⁸ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
⁹ The Watson Institute for International and Public Affairs, Brown University, Providence, RI, United States.
¹⁰ IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, 08003, Barcelona, Spain.
¹¹ CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.
¹² Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain.
¹³ University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica-LIM 23, Rua dr. Ovidio Pires de Campos, 785, São Paulo, CEP, 05403-010, Brazil.
¹⁴ National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, Col San Lorenzo Huipulco, CDMX 14370, Mexico City, Mexico.
¹⁵ Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, UZ Herestraat 49, Box 7003, 3000, Louvain, Belgium.
¹⁶ School of Psychology, Ulster University, Coleraine Campus, Coleraine, BT52 1SA, UK.
¹⁷ Lisbon Institute for Global Mental Health, Comprehensive Health Research Centre Nova University of Lisbon, Rua do Instituto Bacteriológico, 5, 1150-190, Lisbon, Portugal.
¹⁸ Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA.
¹⁹ IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, Italy.
²⁰ Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
²¹ Department of Psychiatry, University of Ibadan, University College Hospital, PMB 5116, Ibadan, Nigeria.
²² Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Dr. Antoni Pujadas, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
²³ Departament de Medicine, Universitat de Barcelona, Barcelona, Spain.
²⁴ Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon.
²⁵ Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Ashrafieh, Beirut, 166378, Lebanon.
²⁶ Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon.
²⁷ Institut de Psychologie, UR 4057, Université Paris Cité, 71 Avenue Édouard Vaillant, 92100, Boulogne Billancourt, Paris, France.
²⁸ Department of Psychiatry, Institute of Psychiatry and Neurology, Jana III Sobieskiego 9, 02-957, Warsaw, Poland.
²⁹ Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/Lorca, nº 58. -El Palmar, 30120, Murcia, Spain.
³⁰ Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, 30120, El Palmar, Murcia, Spain.
³¹ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
³² Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Calle 28 # 5B 02, 11001000, Bogotá, Colombia.
³³ Department of Psychological Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
³⁴ Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Ciudad Autónoma de Buenos Aires, Argentina.
³⁵ National Institute for Health Services Management, Strada Vaselor 31, 030167, Bucharest, Romania.
³⁶ University Titu Maiorescu, Calea Văcărești 187, Bucharest, Romania.
³⁷ Department of Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd., Sofia, 1431, Bulgaria.
³⁸ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA. kessler@hcp.med.harvard.edu.

PMID: 40082956
PMCID: PMC11907907
DOI: 10.1186/s13033-025-00661-1

Abstract

Background: Data from the World Mental Health (WMH) surveys on the coverage cascade has underscored the importance of perceived need for seeking treatment of mental disorders. However, little research has focused on treatment contact after adjusting for perceived need. We do so here in analysis of WMH data.

Methods: The WMH data considered here come from 25 community surveys implemented between 2001 and 2019 across 21 countries. n = 12,508 of the n = 117,739 respondents in these surveys aged 18 and older met criteria for one or more 12-month DSM-IV anxiety, mood, or substance use disorders assessed across all these surveys. Information was obtained about 12-month treatment of each disorder. The predictors considered were disorder type, socio-demographics, and history of prior treatment.

Results: Twelve-month treatment was obtained for 17.7% of the n = 18,702 12-month person-disorders in the sample, including 34.1% for the 46.5% with perceived need and 3.5% for the 54.5% without perceived need. After adjusting for perceived need, receiving treatment was most strongly associated with disorder characteristics (severity, and highest for major depressive, panic/agoraphobia, and generalized anxiety disorders; lowest for substance use disorders), health insurance, employment status (highest for students, the retired, and the unemployed/disabled), and several aspects of prior treatment. These associations were generally similar in cases with and without perceived need for treatment. 12-month treatment among cases who without perceived need and without history of prior treatment was rare (1.1%).

Conclusions: Findings highlight the critical importance of perceived need for obtaining 12-month treatment in the context of other significant predictors involving complexity and severity of disorders and socio-demographic factors. The importance of prior treatment history was quite striking, as was the finding that absence of both perceived need and prior treatment history were associated with a nearly complete absence of treatment. Policy recommendations emerging from these results include the need to increase health literacy, reduce the stigmatization of mental disorder, enhance access through health insurance, and improve the quality of care given the clear evidence that prior experiences with treatment play an important role in determining the likelihood of again seeking treatment for current problems.

Keywords: Mental disorders; Mental health treatment; Perceived need for treatment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study has been performed in accordance with the Declaration of Helsinki. At all survey sites, the local ethics or institutional review committee reviewed and approved the protocol to ensure protection of human subjects, in line with appropriate international and local guidelines. Details of the ethics committees for the WMH surveys can be viewed at this link: http://www.hcp.med.harvard.edu/wmh/ftpdir/WMH_Ethics_approval.pdf Consent for publication: Not applicable. Competing interests: Dr. Dan J. Stein reports personal fees from Discovery Vitality, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Sanofi, Servier, Takeda and Vistagen. In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners Healthcare, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), Roga Sciences and Verisense Health. All other authors report no conflicts of interest related to this manuscript.

References

1. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022;9(2):137–50. - PMC - PubMed
1. Leucht S, Hierl S, Kissling W, Dold M, Davis JM. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br J Psychiatry. 2012;200(2):97–106. - PubMed
1. Cuijpers P, Miguel C, Ciharova M, Harrer M, Basic D, Cristea IA, et al. Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis. World Psychiatry. 2024;23(2):267–75. - PMC - PubMed
1. Vigo DV, Stein DJ, Harris MG, Kazdin AE, Viana MC, Munthali, R, et al. Effective treatment for mental and substance use disorders in 21 countries. JAMA Psychiatry. 2025:e244378. 10.1001/jamapsychiatry.2024.4378. - PMC - PubMed
1. Islam MI, Yunus FM, Isha SN, Kabir E, Khanam R, Martiniuk A. The gap between perceived mental health needs and actual service utilization in Australian adolescents. Sci Rep. 2022;12:5430. - PMC - PubMed

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Patterns and predictors of 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys: treatment in the context of perceived need

Collaborators

Affiliations

Patterns and predictors of 12-month treatment of common anxiety, mood, and substance use disorders in the World Mental Health (WMH) surveys: treatment in the context of perceived need

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources

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